Healthcare Provider Details

I. General information

NPI: 1104812379
Provider Name (Legal Business Name): SARAWOOD RETIREMENT HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 LOOMIS AVE
HOLYOKE MA
01040-2011
US

IV. Provider business mailing address

1 LOOMIS AVE
HOLYOKE MA
01040-2011
US

V. Phone/Fax

Practice location:
  • Phone: 413-532-7879
  • Fax: 413-535-2015
Mailing address:
  • Phone: 413-532-7879
  • Fax: 413-535-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number1905236
License Number StateMA

VIII. Authorized Official

Name: MR. WILLIAM G. LYONS
Title or Position: ADMINISTRATOR
Credential:
Phone: 413-532-7879